TO: DME Providers, Prosthetics & Orthotics (P&O) Providers, Pharmacies,

       Physicians, Physician Assistants, Nurse Practitioners, and Nursing Homes

Effective November 1, 2020, the Oxygen Certification Form (Form 360) can be signed and dated by the DME provider representative if the DME provider is submitting both the prescription signed by the prescriber AND Form 360 to Medicaid’s fiscal agent for prior authorization review. Form 360 must continue to be signed by the prescriber if it is being used as the prescription.

Policy questions concerning this provider notice should be directed to the DME Program at (334) 242-5050.

The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2020 American Medical Association and © 2020 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.